Successful orthotopic liver transplantation after biliopancreatic diversion with duodenal switch

Abstract

Obesity is a major public health concern. In the United States, an estimated 33.8% of adults have a body mass index (BMI) Z30 [1]. In parallel with the evolving obesity epidemic, nonalcoholic fatty liver disease (NAFLD) has rapidly become the most common cause of chronic liver disease worldwide. It is closely associated with a spectrum of disease including steatosis, nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma [2]. In patients undergoing bariatric surgery, steatosis, NASH, and fibrosis can be shown to be present in 61%, 36%, and 16% of patients, respectively [3]. As a consequence, NASH has become one of the most common indications for liver transplantation [2]. To this day, bariatric surgery remains the most effective option for the treatment of morbid obesity and its associated complications. Histologic changes of NAFLD have been shown to improve significantly after weight loss surgery [4], although a paradoxical accelerated form of NASH has also been documented with rapid weight loss [5]. Cases of hepatic failure leading to death or transplantation after bariatric surgery can be found in the literature. Most cases appear to be associated with the jejunoileal bypass procedure and the classic biliopancreatic diversion [6]. In contrast, the biliopancreatic diversion with duodenal switch (BPD/DS), developed in the early 1990s, has only had anecdotal reports of associated severe hepatic failure [7]. To date, liver failure after BPD/DS remains an extremely rare occurrence, and no case of successful liver transplantation in this context has been reported. We report herein a first case of successful orthotopic liver transplantation for subacute hepatic failure 8 months after laparoscopic BPD/DS. (Surg Obes Relat Dis 2013;9;e46–e48.) r 2013